Changes in patient activation following cardiac rehabilitation using the Active+me digital healthcare platform during the COVID-19 pandemic: a cohort evaluation

Abstract

Background Restrictions on face-to-face contact, due to COVID-19, led to a rapid adoption of technology to remotely deliver cardiac rehabilitation (CR). Some technologies, including Active+me, were used without knowing their benefits. We assessed changes in patient activation measure (PAM) in patients participating in routine CR, using Active+me. We also investigated changes in PAM among low, moderate, and high risk patients, changes in cardiovascular risk factors, and explored patient and healthcare professional experiences of using Active+me. Methods Patients received standard CR education and an exercise prescription. Active+me was used to monitor patient health, progress towards goals, and provide additional lifestyle support. Patients accessed Active+me through a smart-device application which synchronised to telemetry enabled scales, blood pressure monitors, pulse oximeter, and activity trackers. Changes in PAM score following CR were calculated. Sub-group analysis was conducted on patients at high, moderate, and low risk of exercise induced cardiovascular events. Qualitative interviews explored the acceptability of Active+me. Results Forty-six patients were recruited (Age: 60.4 ± 10.9 years; BMI: 27.9 ± 5.0 kg.m2; 78.3% male). PAM scores increased from 65.5 (range: 51.0 to 100.0) to 70.2 (range: 40.7 to 100.0; P = 0.039). PAM scores of high risk patients increased from 61.9 (range: 53.0 to 91.0) to 75.0 (range: 58.1 to 100.0; P = 0.044). The PAM scores of moderate and low risk patients did not change. Resting systolic blood pressure decreased from 125 mmHg (95% CI: 120 to 130 mmHg) to 119 mmHg (95% CI: 115 to 122 mmHg; P = 0.023) and waist circumference measurements decreased from 92.8 cm (95% CI: 82.6 to 102.9 cm) to 85.3 cm (95% CI 79.1 to 96.2 cm; P = 0.026). Self-reported physical activity levels increased from 1557.5 MET-minutes (range: 245.0 to 5355.0 MET-minutes) to 3363.2 MET-minutes (range: 105.0 to 12,360.0 MET-minutes; P < 0.001). Active+me was acceptable to patients and healthcare professionals. Conclusion Participation in standard CR, with Active+me, is associated with increased patient skill, knowledge, and confidence to manage their condition. Active+me may be an appropriate platform to support CR delivery when patients cannot be seen face-to-face. Trial registration As this was not a clinical trial, the study was not registered in a trial registry.

Role of wearable devices in cardiac telerehabilitation: A scoping review

“…The number of participants ranged from 5 [ 28 ] to 2331 [ 17 ]. The number of participants who did not complete the study ranged from 0 [ 26 , 44 , 52 , 57 , 66 ] to 150 [ 58 ] participants, translating to an incompletion rate of 0% to 92.6%. Three studies did not report a dropout rate [ 37 , 19 , 62 ].…”

Second Nationwide Survey of Japanese Cardiac Rehabilitation Training Facilities During the Coronavirus Disease 2019 (COVID-19) Outbreak

“…Cardiac telerehabilitation has the potential to increase the low CR participation rate in Japan. 14 , 15 In the UK, nearly half of all CR programs have been suspended due to COVID-19 restrictions. Technology was rapidly adopted by CR services; this may increase participation beyond COVID-19.…”

Experiences of patients with multimorbidity with primary care and the association with patient activation: a cross-sectional study in Germany

“…18 Some studies looking at different interventions like online programmes or walking interventions over a period of time showed that patient activation may be changeable. [19][20][21] Thus, there are many studies reporting the association of patient activation with clinical outcomes and healthrelated behaviour. Therefore, it would be helpful to identify which aspects that can be directly addressed by primary care physicians are linked to higher patient activation.…”

“… 18 Some studies looking at different interventions like online programmes or walking interventions over a period of time showed that patient activation may be changeable. 19–21 …”